CUTANEOUS REACTIONS FOLLOWING HERPES-ZOSTER INFECTIONS - REPORT OF 3 CASES AND A REVIEW OF THE LITERATURE

Three patients, one healthy and two immunocompromised, developed cutan eous reactions that histologically mimicked granuloma annulare at site s of resolved varicella-zoster virus (VZV) reactivation infections. Va riable latency periods between the infection and the granulomatous rea ction were noted. As in other case reports, the presence of VZV DNA in these lesions was inconsistently demonstrated by the polymerase chain reaction (PCR) and appears more common in early, as opposed to late, post-tester granulomas. In addition to various granulomatous reactions , vasculitic and neoplastic eruptions following resolved VZV infection s have been described and are reviewed here. Therapeutically, topical, intralesional and systemic corticosteroids, as well as acyclovir, hav e been tried with inconsistent results. Although the pathogenesis rema ins unclear, the presence of VZV DNA in early lesions that histologica lly do not display viral cytopathic changes, suggests the virus induce s an atypical delayed hypersensitivity reaction not affected by antivi ral therapy.